Helping those that are Underinsured: What are Genetic Counselors doing to help their patients get BRCA1/2 testing covered?

Abstract:

According to the U.S. Preventative Services Task Force (USPSTF, 2005), anyone with a personal or significant family history of breast or ovarian cancer should be offered BRCA1/2 testing. Patients who are underinsured (i.e. who have a health insurance policy that does not cover enough of the test’s cost, thus making it unaffordable) may be unable to follow through with these recommendations. However, underinsured patients may be eligible for funding from charitable resources such as the Cancer Resource Foundation Inc. The purpose of this study was to explore cancer genetic counselors’ knowledge regarding financial assistance programs for underinsured patients seeking genetic testing, and to assess the frequency with which they refer patients to such programs. We recruited cancer genetic counselors based in the United States through an NSGC e-blast for participation in an anonymous, online survey. Of the 178 genetic counselors who responded, nearly all (99%) reported that they assist patients in obtaining insurance coverage for BRCA1/2 genetic testing. Participants reported that between December 2011 and December 2012, an average of 11% of their patients canceled their testing due to insurance coverage. Of those patients, the majority (~ 60%) canceled because they were underinsured. Many of the participants reported using the Cancer Resource Foundation Inc. (43%) or a hospital grant/fund (33%) to assist patients with payment for testing. The participants reported encountering two major problems when trying to obtain funding. First, in many instances the patients did not provide the required documentation for the application. Second, counselors cited funding limitations, including regional variability in the availability of funds and insufficient funding to cover all patients. With the implementation of the Affordable Care Act, BRCA1/2 testing will now become a preventative care service, which will hopefully allow for more patients to be able to proceed with testing.